IMPROVING LUNG CANCER SCREENING RATES IN AN UNDERSERVED OUTPATIENT CLINIC

Abstract

SESSION TITLE: Lung Cancer Screening: New Questions and New Answers SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: Improve lung cancer screening ratesEducate residents and staff on the USPSTF lung cancer screening criteria METHODS: Lung cancer is the leading cause of cancer death worldwide and in the United States. Despite its massive mortality, no screening method was available until this decade. The National Lung Cancer Screening Trial (NLST) demonstrated in 2011 that lung cancer screening in high risks patients using low dose chest computed tomography (LDCT) resulted in a 20% relative reduction in lung cancer-related mortality compared to chest X-Ray screening. Hence, the USPSTF recommended (grade B) in December 2013 annual LDCT for lung cancer screening in adults age 55-80 years, who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.We performed a retrospective review of current and former smokers evaluated by a primary care provider over a six month period in 2017 in our inner city community health center. Patients that met the USPSTF criteria for lung cancer screening were selected and data regarding LDCT ordering and completion was collected. Microsoft Excel was used for data tabulation and analysis. We aim to improve our screening compliance by 20% in 6 months by implementing electronic medical records reminders, staff educational sessions, and telephone reminders to patients. RESULTS: 577 patients were identified and total of 108 patients met the USPSTF criteria for screening. A total of 287 patients (49%) were excluded as the numbers of pack per year were unable to be calculated. Of the 108 patients, 67% were current smoker and 33% former smokers. The mean age was 65 with 54% male and 46% female. A total of 57% of the patients identified as Hispanic or Latino and 70% of the patients selected English as their primary language. A LDCT was ordered by a physician in 32% (N=35) of cases and completed in only 18 patients, resulting in a net rate of screening compliance of 17%. Among those ordered, 17 patients (48.5%) did not complete their LDCT due to multiple reasons. The most common reaston of not completing LDCT was no missing/no-show to their appointment (73% of cases). Other reasons included insurance denial in 12%, or patient cancellation or re-scheduling in 12%. CONCLUSIONS: By highlighting our poor adherence to lung cancer screening guidelines, we hope to provide improvement to our screening rates and provide a valuable approach for other institutions. CLINICAL IMPLICATIONS: Lung cancer screening with low-dose CT yielded a 20% reduction in lung cancer mortality. In our study a total of 49% of the patients were excluded due to incomplete electronic medial record documentation. By addressing the importance of documentation to residents and staffs, a substantial number of patients can benefit from this screening. Also, addressing the higher number of no-show appointments can improve the compliance of lung cancer screening. DISCLOSURES: No relevant relationships by Carlos Rodriguez-Bonilla, source=Web Response No relevant relationships by Alan Tso, source=Web Response No relevant relationships by ANA VELAZQUEZ MANANA, source=Web Response